Individual provider Active NPI

Kathlene Herbermann, AA

  • Anesthesiologist Assistant
  • Stockbridge, GA
National Provider Identifier
1619297918
Registry record updated Jun 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
Practice address
1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085
Phone
(678) 604-1053
Fax
(678) 604-5548
NPI assigned
Jun 9, 2010
Last updated
Jun 9, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X GA Primary

Addresses

Primary practice location

1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085

Mailing address

909 Eagles Landing Pkwy
Suite 140-214
Stockbridge, GA 30281-7247
Phone (678) 604-1053

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170603000033 FL Practitioner - Anesthesiology Assistant 8426246703 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Emory University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (954) 939-5000

1670 St Vincents Way
Middleburg, FL 32068-8447
Phone (954) 939-5000

205 Trinity Way
St Johns, FL 32259-1155
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
005959GAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Anesthesia Consultants, Inc. CurrentSince May 4, 2017 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Current Accepting new patients
North Florida Anesthesia Consultants Inc CurrentSince May 4, 2017 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Feb 4, 2019 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Feb 4, 2019 Accepting new patients

Locations

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276041600000",
    "number": "1619297918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 EAGLES LANDING PKWY",
            "address_2": "SUITE 140-214",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817247",
            "telephone_number": "678-604-1053",
            "fax_number": "678-604-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815085",
            "telephone_number": "678-604-1053",
            "fax_number": "678-604-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBERMANN",
        "first_name": "KATHLENE",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-09",
        "last_updated": "2010-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.